Healthcare Provider Details

I. General information

NPI: 1942383401
Provider Name (Legal Business Name): DAVID LICHTENSTEIN PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 BEACH 129 STREET
BELLE HARBOR NY
11694-1516
US

IV. Provider business mailing address

431 BEACH 129 STREET
BELLE HARBOR NY
11694-1516
US

V. Phone/Fax

Practice location:
  • Phone: 718-318-3434
  • Fax: 718-318-3723
Mailing address:
  • Phone: 718-318-3434
  • Fax: 718-318-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number160524-1
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID IRA LICHTENSTEIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-318-3434